Discussion Board

Discussion Board

[Name of the Writer]

[Name of the Institution]

Discussion Board

In America, the government has introduced different policies and programs to improve the quality of healthcare. Government is providing services through health plans like Medicare and Medicaid. Health insurance is a crucial factor in the programs introduced to cover the maximum population. However, the past few years noticed the high healthcare cost in the nation. People are not getting equal benefits from insurance programs. The main factors for the ineffectiveness of the program are the innovation and determining the coverage policy. Technological advancement is helping the nation to determine better health quality; however, it also demands high spending. Increase in the spending on innovation and effectiveness of specific drug/procedure determining the coverage policy is necessary to analyze the best interventions and preventions. Both government and private health programs mostly rely on decision making on evidence criteria instead of cost-effectiveness analysis ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"QOGx88bt","properties":{"formattedCitation":"(Garber, 2004)","plainCitation":"(Garber, 2004)","noteIndex":0},"citationItems":[{"id":975,"uris":["http://zotero.org/users/local/mlRB1JqV/items/67WK9SXN"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/67WK9SXN"],"itemData":{"id":975,"type":"article-journal","title":"Cost-Effectiveness And Evidence Evaluation As Criteria For Coverage Policy: Cost-effectiveness analysis could shift from being an academic curiosity to an essential tool for health care decision making.","container-title":"Health Affairs","page":"W4-284-W4-296","volume":"23","issue":"Suppl1","source":"DOI.org (Crossref)","abstract":"Private health plans and government health insurance programs in the United States base their coverage decisions on evidence criteria, rather than explicit costeffectiveness criteria. As health spending continues to grow rapidly, however, approaches to coverage policy that ignore costs fail to meet the needs of consumers, employers, health plans, and federal and state governments. I describe the role of evidence-based criteria in formal coverage decision making and contrast the ways that these criteria differ from cost-effectiveness criteria. Finally, I discuss options for incorporating considerations of cost-effectiveness into coverage policy and other aspects of benefit design.","DOI":"10.1377/hlthaff.W4.284","ISSN":"0278-2715, 1544-5208","title-short":"Cost-Effectiveness And Evidence Evaluation As Criteria For Coverage Policy","journalAbbreviation":"Health Affairs","language":"en","author":[{"family":"Garber","given":"Alan M."}],"issued":{"date-parts":[["2004",1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Garber, 2004).

Cost-effectiveness analysis cannot be helpful to reduce the cost in the long run. The method is useful to determine the cost of prevention or intervention by analyzing the difference between the benefits of the service with respect to its cost. However, in contemporary time it has more drawbacks than benefits. For instance, to determine the best intervention cost-effectiveness ratio is used but the results of the intervention presented in the “league table” are often obtained from incompatible methods. Besides, the cost-effectiveness criterion is not easy to complete when the interventions are expensive. Another drawback of the cost-effectiveness analysis is the sample size. For instance, the researchers often use the willingness of individuals to pay for better health. Though priorities, issues, economic condition, and similar factors are affecting willingness vary from person to person. Proponents apply the result of a small sample population to an entire population which might be ineffective or even problematic for the healthcare quality improvement ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"hEisz8Qj","properties":{"formattedCitation":"(Pauly, 2015)","plainCitation":"(Pauly, 2015)","noteIndex":0},"citationItems":[{"id":973,"uris":["http://zotero.org/users/local/mlRB1JqV/items/6Z44R9MY"],"uri":["http://zotero.org/users/local/mlRB1JqV/items/6Z44R9MY"],"itemData":{"id":973,"type":"article-journal","title":"Cost-effectiveness analysis and insurance coverage: solving a puzzle","container-title":"Health Economics","page":"506-515","volume":"24","issue":"5","source":"PubMed","abstract":"The conventional model for the use of cost-effectiveness analysis for health programs involves determining whether the cost per unit of effectiveness of the program is lower than some socially determined maximum acceptable cost per unit of effectiveness. If a program is better by this criterion, the policy implication is that it should be implemented by full coverage of its cost by insurance; if not, the program should not be implemented. This paper examines the unanswered question of how cost-effectiveness analysis should be performed and interpreted when insurance coverage may involve cost sharing. It explores the question of how cost sharing should be related to the magnitude of a cost-effectiveness ratio. A common view that cost sharing should vary inversely with program cost-effectiveness is shown to be incorrect. A key issue in correct analysis is whether there is heterogeneity in marginal effectiveness of care that cannot be perceived by the social planner but is known by the demander. It is possible that some programs that would fail the social efficiency test at full coverage will be acceptable with positive cost sharing. Combining individual and social preferences affects both the choice of programs and the extent of cost sharing.","DOI":"10.1002/hec.3044","ISSN":"1099-1050","note":"PMID: 24677289","title-short":"Cost-effectiveness analysis and insurance coverage","journalAbbreviation":"Health Econ","language":"eng","author":[{"family":"Pauly","given":"Mark"}],"issued":{"date-parts":[["2015",5]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Pauly, 2015). Therefore, the bottom line is that cost-effectiveness analysis alone might not be effective, however, combined with the evidence criteria might help the government to achieve their healthcare goals.

References

ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Garber, A. M. (2004). Cost-Effectiveness And Evidence Evaluation As Criteria For Coverage Policy: Cost-effectiveness analysis could shift from being an academic curiosity to an essential tool for health care decision making. Health Affairs, 23(Suppl1), W4-284-W4-296. https://doi.org/10.1377/hlthaff.W4.284

Pauly, M. (2015). Cost-effectiveness analysis and insurance coverage: Solving a puzzle. Health Economics, 24(5), 506–515. https://doi.org/10.1002/hec.3044